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Guides you through decision to use medicine or surgery to treat GERD. Covers medicines like antacids and esomeprazole (Nexium). Discusses laparoscopic surgery. Looks at pros and cons of each. Includes interactive tool to help you make your decision.

GERD: Which Treatment Should I Use?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

GERD (gastroesophageal reflux disease) is the flow of
stomach juices back up into the
esophagus. This backup, called reflux, happens if the
valve between the lower end of the esophagus and the
stomach doesn't close tightly enough.

The most common symptom is
heartburn, an uncomfortable feeling of burning or pain
just behind the breastbone. Another common symptom is a sour taste in the
mouth.

People
with very bad, untreated GERD symptoms may get esophagitis (say
"ee-saw-fuh-JY-tus"). This means that the esophagus is inflamed and irritated
from the constant contact with stomach acids and digestive juices. GERD also
can cause
Barrett's esophagus, which is a change in the cells
lining the esophagus. In rare cases, it may lead to cancer.

Treatment usually starts with
lifestyle changes—such as quitting smoking and losing weight—and
with medicines that you can buy without a prescription. These medicines reduce or
block stomach acid. They include
H2 blockers (such as Pepcid and Zantac) and
proton pump inhibitors (such as Prevacid and Prilosec).

Talk to your doctor if
over-the-counter medicines aren't controlling your
symptoms. In most cases, he or she can prescribe other medicine to help control
your symptoms.

The most common surgery for GERD is called
fundoplication surgery. It involves wrapping part of
the stomach around the esophagus to strengthen it. If you have a
hiatal hernia, it also will be fixed.

This surgery is often done
laparoscopically. Instead of making a large cut
(incision) in the belly, the doctor puts a lighted tube, or scope, and surgical
tools into small cuts in your belly. This allows the doctor to see into your
belly to do the surgery.

You may decide to have surgery if:

Medicines don't relieve your symptoms
enough.

Medicine works to stop your symptoms, but for other reasons you can't or don't want to take the medicine.

You have other problems that don't get better with
medicine, such as
asthma, hoarseness, or a cough caused when the acid
backs up in your throat.

Treating GERD in pregnant women

Lifestyle changes and antacids are usually tried first
to treat pregnant women who have GERD. Antacids are safe to use for heartburn
symptoms during pregnancy. If lifestyle changes and antacids don't help control
your symptoms, talk to your doctor about using other medicines.

H2 blockers work to help symptoms of GERD. But the number of people who take H2 blockers and who have no GERD symptoms is usually less than 5 out of 10 people. That means that of the people taking H2 blockers, more than 5 out of 10 still have some GERD symptoms.1

Proton pump inhibitors (PPIs) work to help symptoms of GERD. But the number of people who take PPIs and who have no GERD symptoms is usually less than 5 out of 10 people. That means that of the people taking PPIs, more than 5 out of 10 still have some GERD symptoms.1

You may need to try more than one medicine to find one
that works well for you. And you may still sometimes need to take an antacid (such as Mylanta or Tums) to stop heartburn.

The medicines

Antacids, such as Gaviscon or Rolaids. Antacids work very well for people who get mild to moderate
heartburn now and then. They relieve symptoms quickly. You can buy these
without a prescription in grocery stores and drugstores. Antacids probably
won't help people who have bad symptoms.

H2 blockers, such as Pepcid or Tagamet. H2 blockers
help most people with mild to moderate heartburn. You can get them with or
without a prescription.

Proton pump inhibitors, such as Prevacid or Prilosec. These medicines are used to treat GERD symptoms and inflammation of the esophagus (esophagitis). Some are available without a prescription.

No matter which medicines you try, making lifestyle
changes is still an important part of your treatment.

If your GERD
symptoms are very bad, you will probably need to take medicines every day.
That's because symptoms tend to return if you stop taking medicine.

The
medicines for GERD are generally safe, but each has different side
effects.

Antacids that
contain aluminum may cause constipation. Those that contain magnesium may cause
diarrhea. You should not use antacids that contain either aluminum or magnesium
if you have serious kidney problems. If you are on a low-salt diet or are pregnant, talk with your doctor or pharmacist before you choose an antacid. Some are high in salt. The ingredients are listed on the package
or bottle.

H2 blockers are
considered very safe. But they sometimes cause headaches, dizziness, diarrhea
or constipation, or nausea and vomiting.

Proton pump inhibitors don't
usually cause problems. Headaches and diarrhea are the most frequent side
effects.

Surgery
relieves symptoms for most people, but not for everyone. Laparoscopic surgery improves GERD symptoms in 8 out of 10 people. And surgery heals the damage done by GERD to the esophagus (esophagitis) in about 9 out of 10 people.2

Personal stories about medicines and surgery to treat GERD

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I was having tests for another health problem when my doctor discovered I have a hiatal
hernia. She told me the hiatal hernia could be causing the heartburn I have from time to time. She told me I could take medicine when my heartburn is really bothering me. She also suggested that I try to lose some weight and eat right. I am hoping that these
lifestyle changes, along with medicine when I have bad symptoms, will control my heartburn.

Carlos, age
43

I was glad to learn that my chest pain was
GERD. I thought I was having a heart attack. My doctor said I could treat
the symptoms with medicine. But because I was having symptoms so often, he said the medicine would work best if I took it every day at the same time (30 minutes before breakfast). If I remember to take my medicine, I don't have any heartburn. Now I hope I will be able to get on with my life and not be bothered
by this quite so much.

Maria, age 28

My
heartburn was really bad. I tried everything. First it was antacids and other
medicines I bought at the drugstore. That didn't help, so I saw my doctor. He
wrote me a prescription for stronger medicines. That helped some, but not enough. So after doing tests to make sure my symptoms were caused by GERD, my doctor said I could consider having surgery. He told me about the possible new symptoms I could have including trouble swallowing or burping and extra gas or bloating. But my GERD is so bad, I'm willing to take my chances. I decided to have surgery.

Antoine, age
40

I decided to take medicine for my
GERD instead of having surgery. It's not so much that I am afraid of
surgery, but I really don't have the time to take off right now. Taking a pill
every day is not that big a deal. If it works, great! And I don't know what new problems I might have after surgery. If medicine works for me, why would I try something more risky?

Susan, age 50

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take medicines for GERD

Reasons to have surgery for GERD

I'm not worried about the side effects of taking medicines.

I want to avoid taking medicine or at least reduce how much medicine I'll need.

More important

Equally important

More important

I want to avoid having surgery if at all possible.

I'm not worried about having surgery.

More important

Equally important

More important

I can make lifestyle changes and try different medicines.

I have been trying medicines for some time, and my symptoms are still bad.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicine

Having surgery

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Do frequent heartburn and other symptoms of GERD often go away on their own?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

GERD: Which Treatment Should I Use?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Use medicines to treat symptoms of GERD (gastroesophageal
reflux disease).

Most people can control
symptoms of GERD with
over-the-counter medicines and lifestyle changes.

Stronger prescription medicines often work when over-the-counter
medicines don't.

You may decide to have surgery if:

Medicine doesn't completely relieve your
symptoms.

Medicine works to stop your symptoms but for other reasons you can't or don't want to take the medicine.

You have other symptoms, including asthma or hoarseness,
that do not get much better with medicines.

Surgery has risks, some of which may be
serious.

Surgery may cause side effects, such as trouble
swallowing and permanent painful gas from not being able to burp.

The best surgery results are with doctors who have done this
surgery many times. Talk to your doctor about how many GERD surgeries he or she
has done.

After surgery, you still may need to take medicines to control
symptoms.

FAQs

What is GERD?

GERD (gastroesophageal reflux disease) is the flow of
stomach juices back up into the
esophagus. This backup, called reflux, happens if the
valve between the lower end of the esophagus and the
stomach doesn't close tightly enough.

The most common symptom is
heartburn, an uncomfortable feeling of burning or pain
just behind the breastbone. Another common symptom is a sour taste in the
mouth.

People
with very bad, untreated GERD symptoms may get esophagitis (say
"ee-saw-fuh-JY-tus"). This means that the esophagus is inflamed and irritated
from the constant contact with stomach acids and digestive juices. GERD also
can cause
Barrett's esophagus, which is a change in the cells
lining the esophagus. In rare cases, it may lead to cancer.

How is GERD treated?

Treatment usually starts with
lifestyle changes—such as quitting smoking and losing weight—and
with medicines that you can buy without a prescription. These medicines reduce or
block stomach acid. They include
H2 blockers (such as Pepcid and Zantac) and
proton pump inhibitors (such as Prevacid and Prilosec).

Talk to your doctor if
over-the-counter medicines aren't controlling your
symptoms. In most cases, he or she can prescribe other medicine to help control
your symptoms.

The most common surgery for GERD is called
fundoplication surgery. It involves wrapping part of
the stomach around the esophagus to strengthen it. If you have a
hiatal hernia, it also will be fixed.

This surgery is often done
laparoscopically. Instead of making a large cut
(incision) in the belly, the doctor puts a lighted tube, or scope, and surgical
tools into small cuts in your belly. This allows the doctor to see into your
belly to do the surgery.

You may decide to have surgery if:

Medicines don't relieve your symptoms
enough.

Medicine works to stop your symptoms, but for other reasons you can't or don't want to take the medicine.

You have other problems that don't get better with
medicine, such as
asthma, hoarseness, or a cough caused when the acid
backs up in your throat.

Treating GERD in pregnant women

Lifestyle changes and antacids are usually tried first
to treat pregnant women who have GERD. Antacids are safe to use for heartburn
symptoms during pregnancy. If lifestyle changes and antacids don't help control
your symptoms, talk to your doctor about using other medicines.

How well do medicines work for GERD?

Medicines
relieve
GERD symptoms for most people.

H2 blockers work to help symptoms of GERD. But the number of people who take H2 blockers and who have no GERD symptoms is usually less than 5 out of 10 people. That means that of the people taking H2 blockers, more than 5 out of 10 still have some GERD symptoms.1

Proton pump inhibitors (PPIs) work to help symptoms of GERD. But the number of people who take PPIs and who have no GERD symptoms is usually less than 5 out of 10 people. That means that of the people taking PPIs, more than 5 out of 10 still have some GERD symptoms.1

You may need to try more than one medicine to find one
that works well for you. And you may still sometimes need to take an antacid (such as Mylanta or Tums) to stop heartburn.

The medicines

Antacids, such as Gaviscon or Rolaids. Antacids work very well for people who get mild to moderate
heartburn now and then. They relieve symptoms quickly. You can buy these
without a prescription in grocery stores and drugstores. Antacids probably
won't help people who have bad symptoms.

H2 blockers, such as Pepcid or Tagamet. H2 blockers
help most people with mild to moderate heartburn. You can get them with or
without a prescription.

Proton pump inhibitors, such as Prevacid or Prilosec. These medicines are used to treat GERD symptoms and inflammation of the esophagus (esophagitis). Some are available without a prescription.

No matter which medicines you try, making lifestyle
changes is still an important part of your treatment.

If your GERD
symptoms are very bad, you will probably need to take medicines every day.
That's because symptoms tend to return if you stop taking medicine.

What are the side effects of GERD medicines?

The
medicines for GERD are generally safe, but each has different side
effects.

Antacids that
contain aluminum may cause constipation. Those that contain magnesium may cause
diarrhea. You should not use antacids that contain either aluminum or magnesium
if you have serious kidney problems. If you are on a low-salt diet or are pregnant, talk with your doctor or pharmacist before you choose an antacid. Some are high in salt. The ingredients are listed on the package
or bottle.

H2 blockers are
considered very safe. But they sometimes cause headaches, dizziness, diarrhea
or constipation, or nausea and vomiting.

Proton pump inhibitors don't
usually cause problems. Headaches and diarrhea are the most frequent side
effects.

How well does surgery work for GERD?

Surgery
relieves symptoms for most people, but not for everyone. Laparoscopic surgery improves GERD symptoms in 8 out of 10 people. And surgery heals the damage done by GERD to the esophagus (esophagitis) in about 9 out of 10 people.2

What are the risks and side effects of surgery?

All
major surgery has risks, including a risk of breathing problems caused by the
anesthesia. There also is a risk of bleeding,
infection, and pain.

Surgery for GERD can involve other problems:

Surgery might not make symptoms go away completely.

Some people still need to take medicine for GERD symptoms after surgery.

Some people have increased flatulence and bloating after surgery.

It is also possible for the stomach wrap to slide
down around the stomach instead of staying around the esophagus. If this rare
problem happens, you may need surgery to fix it.

The stomach wrap
could loosen, causing symptoms to return. You might need a second surgery to
fix it.

Why might your doctor recommend surgery for GERD symptoms?

Your doctor might recommend surgery if:

Medicine doesn't completely relieve your
symptoms.

Medicine works to stop your symptoms but for other reasons you can't or don't want to take the medicine.

You have other symptoms, including
asthma or hoarseness, that don't get much better with
medicines.

2. Compare your options

Take medicines

Have surgery

What is usually involved?

You take medicine every day to prevent GERD symptoms.

You take over-the-counter medicines if you still get some heartburn.

You make lifestyle changes if needed, such as
quitting smoking, losing weight, or changing your
eating habits.

You stay in the hospital for
several days. The hospital stay is usually shorter for laparoscopic
surgery.

You may need to eat only soft foods until you heal.

You make lifestyle changes if needed, such as
quitting smoking, losing weight, or changing your
eating habits.

What are the benefits?

Medicines such as
H2 blockers and
proton pump inhibitors work well for most people who
have mild to moderate heartburn.

Surgery may heal damage to the esophagus a little bit better than medicine (proton pump inhibitors).3

What are the risks and side effects?

Medicines can
cause side effects:

H2 blockers can cause headaches,
dizziness, diarrhea or constipation, and nausea and vomiting.

Proton pump inhibitors can cause headaches and diarrhea.

Any surgery has
risks, such as bleeding and infection.

Some people have trouble swallowing after surgery.

Some people have increased flatulence and bloating after surgery.

Some people are unable to belch after surgery.

Surgery
may not completely get rid of symptoms.

You still may have to take
medicine after surgery.

Some people need a second surgery.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about medicines and surgery to treat GERD

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I was having tests for another health problem when my doctor discovered I have a hiatal hernia. She told me the hiatal hernia could be causing the heartburn I have from time to time. She told me I could take medicine when my heartburn is really bothering me. She also suggested that I try to lose some weight and eat right. I am hoping that these lifestyle changes, along with medicine when I have bad symptoms, will control my heartburn."

— Carlos, age
43

"I was glad to learn that my chest pain was GERD. I thought I was having a heart attack. My doctor said I could treat the symptoms with medicine. But because I was having symptoms so often, he said the medicine would work best if I took it every day at the same time (30 minutes before breakfast). If I remember to take my medicine, I don't have any heartburn. Now I hope I will be able to get on with my life and not be bothered by this quite so much."

— Maria, age 28

"My heartburn was really bad. I tried everything. First it was antacids and other medicines I bought at the drugstore. That didn't help, so I saw my doctor. He wrote me a prescription for stronger medicines. That helped some, but not enough. So after doing tests to make sure my symptoms were caused by GERD, my doctor said I could consider having surgery. He told me about the possible new symptoms I could have including trouble swallowing or burping and extra gas or bloating. But my GERD is so bad, I'm willing to take my chances. I decided to have surgery."

— Antoine, age
40

"I decided to take medicine for my GERD instead of having surgery. It's not so much that I am afraid of surgery, but I really don't have the time to take off right now. Taking a pill every day is not that big a deal. If it works, great! And I don't know what new problems I might have after surgery. If medicine works for me, why would I try something more risky?"

— Susan, age 50

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take medicines for GERD

Reasons to have surgery for GERD

I'm not worried about the side effects of taking medicines.

I want to avoid taking medicine or at least reduce how much medicine I'll need.

More important

Equally important

More important

I want to avoid having surgery if at all possible.

I'm not worried about having surgery.

More important

Equally important

More important

I can make lifestyle changes and try different medicines.

I have been trying medicines for some time, and my symptoms are still bad.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicine

Having surgery

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Do frequent heartburn and other symptoms of GERD often go away on their own?

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